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Ritalin - A Corresponding Issue in Terms of Cultural Diversity

The most surprising thing I ever saw as a counseling intern in American Schools is that there were many children lining up everyday in front of the nursing room for their medication. In the United States, school nurses keep the whole medicines for children under some medication. Ritalin is the most common drug in the nursing room. It is a piperidine-derived central nervous system stimulant, widely used as a psychostimulant for the treatment of attention-deficit hyperactivity disorder (ADHD) in children in the United States (Schwartz, 2002). According to the Drug Enforcement Agency, the production of Ritalin in the U.S. has increased from 1,361 kilograms in 1990 to 10,410 kilograms in 1995 with a 7-fold increase in production. The increases in a production and the use of Ritalin are striking when they are compared to the worldwide data. According to the United Nations, the U.S. produces and consumes about 85% of the world's production of Ritalin (International Narcotics Control Board Report, 1999). It seems that only the U.S. has many more cases of ADHD than other countries. What is the perspective lying under the widespread use of this drug in the U.S.?

On the other hand, Ritalin has not been approved for the prescription for ADHD by the government in Japan, Ministry of Health, Labor and Welfare (MHLW), while the US government approved it over 25 years ago. The reason of being unapproved in Japan, according to the MHLW, is that the long-term safety of Ritalin has not been assured yet. In addition, it is only recently that Japanese people began to recognize ADHD as a disorder, while there were as many as 1 million children taking Ritalin in the school for their medication as of 1998 (U.S. News & World Report, 1998). Here I see some gaps or differences in the attitude toward medication between the two countries. Certain medicine is approved in one country but unapproved in another country? Why does such a situation happen? This leads to some issues of ethnicity and culture.

Ethnicity and cultural expectation might explain the massive consumption of Ritalin in the U.S. Given that American society is often described as "competitiveness" (Sue, 2003), it might well be true that once some children start taking Ritalin for performance enhancement, there will be social pressure on other children to also take it. Many children and parents are looking at short-term effects and depend on the medicine to survive in a competitive society. With more careful research, I found an interesting data. ARCOS (Automation of Reports and Consolidated Orders System) data from the Drug Enforcement Agency indicates that there is a wide variability in the use of Ritalin from one state to another. According to the data, California and Hawaii had the lowest use of Ritalin in the U.S. In Hawaii, the ratio of Euro-Americans (white Americans) is 24.3%, which is the lowest rate in the country. Similarly, the ratio of Euro-Americans in California is 59.5%, which is the second lowest in the country (U.S. Census Bereau, 2000). And both states have the highest ratio of Asian people. This data suggest that the difference in the use of Ritalin depends on each ethnicity, not on the whole society. Of course, those gaps in the Ritalin use might be attributed simply to socio-economic status, but I believe that cultural factors, rather than economic factors, may explain the low rates of ADHD medication in Asian groups.

Numerous studies have been focused on the effectiveness of the ADHD treatment or the medication's possible link to substance abuse in the later life. However, I believe that cultural perspectives should be paid more attention and we need to consider why such differences exist among countries and ethnicities. ADHD treatment is a huge issue, and I would like to examine the corresponding issues around ADHD medication in terms of cultural diversity. Further research would be needed to answer the questions I raised in this paper.

References:
Schwarts, Klein., PharmD, Wendy. (2002). Abuse and toxicity of methylphenidate. Current Opinion in Pediatrics, 14 (2), April, 219-223.

U.S. Drug Enforcement Agency (1995). Methylphenidate Review Document. Washington, DC: Office of Diversion Control, Drug and Chemical Evaluation Section.

U.S. Drug Enforcement Agency (2000). DEA congressional testimony [On line]. Available at: www.usdoj.gov/pubs/cngrtest/ct051600.htm

U.S. Census Bureau (2000). United States Census 2000 [On line]. Available at: http://www.census.gov/

Sue, D., & Sue D., (2003). Counseling the Culturally Diverse: Theory and Practice. Wiley.
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